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High-Yield Facts

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  • Most childhood exanthems are benign, self-limited, and require no treatment; but hidden in this presentation is an occasional myocarditis, encephalitis, or pneumonia.

  • Worldwide, rubeola is still a major cause of morbidity and mortality. Early recognition can control spread.

  • Roseola infantum is a common cause of febrile seizures in infants. A full fontanelle may be present in up to 25%.

  • Children with varicella that may benefit from antiviral agents include patients on corticosteroids or chronic salicylates, immunocompromised patients, and those older than 12 years.

  • Neonatal herpes has three presentations in the first 6 weeks of life: Encephalitis with seizures, disseminated with a “neonatal sepsis” appearance, and those localized to the skin, eye(s), and mouth. Early treatment with acyclovir will prevent progression.

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Introduction

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The vast majority of childhood exanthems are a result of nonspecific, self-limited viral illnesses. However, recognizing their patterns being familiar with the history and physical findings associated with these specific exanthems can be crucial to reassuring families, educating, and directing care.

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The clinician should always be vigilant to recognize associated symptoms that may suggest life-threatening complications when examining children with exanthems. This chapter will describe recognizable childhood exanthems, discuss risks of exposure, and provide an understanding of complications to expect and serious sequelae to consider.

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Rubeola (Measles)

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Epidemiology/Pathophysiology
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Rubeola, more commonly known as measles, is one of the most contagious diseases known to man with a 90% transmission rate to an unimmunized household contact. Although, widespread use of live virus vaccine during the past 40 years has dramatically reduced the incidence of the disease in developed countries, measles still remains a leading cause of preventable childhood morbidity and mortality worldwide. In 2010, measles resulted in 139,300 deaths worldwide, with more than 95% of these deaths occurred in developing countries. Maternally acquired antibodies usually are sufficient to protect against clinical exposure in infants younger than 1 year of age. In the United States, the AAP recommends vaccination with MMR (Measles, Mumps, Rubella) between 12 to 15 months of age and a second dose at 5 years. In 2010, 85% of the world's children received at least one dose of the measles vaccines before their first birthday. Because of a successful vaccination campaign, most cases today are limited to immunocompromised patients and patients in developing countries where poverty and malnutrition is a factor.1

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Transmission of the virus is by aerosol exposure or contact with respiratory fluids. The virus enters the body through the respiratory tract, and the incubation period ranges from 7 to 18 days after exposure. Patients are contagious for approximately 5 days after onset of symptoms, which usually begin with fever.

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Clinical Findings
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The characteristic measles rash is usually preceded by 3 days of fever to 40°C and the characteristic “three Cs”—cough, coryza, and conjunctivitis. Intense mucoid nasal ...

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